Urgent Care Evaluation of Pain and Swelling in the Scrotum

September 2026 Postscript #1

Test Your Knowledge

A 27-year-old man presents with 3 days of gradually worsening left testicular pain and swelling. He reports dysuria and urinary frequency but denies trauma, nausea, or vomiting. During a private sexual history, he reports a new sexual partner and inconsistent condom use. Examination reveals mild left scrotal swelling and tenderness greatest over the epididymis. Both testes have a normal vertical lie, and the cremasteric reflex is present bilaterally. There is no blue dot sign or inguinal mass. Urinalysis demonstrates leukocyte esterase and pyuria.

Which of the following is the most appropriate next step?

1. Obtain gonorrhea and chlamydia testing and treat empirically for likely infectious epididymo-orchitis
2. Immediate transfer for surgical exploration for presumed testicular torsion
3. Provide reassurance and NSAIDs without additional testing
4. Arrange urgent urologic referral for suspected testicular cancer